title: Analysis of the delay components in the treatment of status epilepticus.
abstract: BACKGROUND
  The factors comprising the delays in management of status epilepticus (SE) have not been systematically studied.
  
  
  METHODS
  We studied retrospectively all adult patients (N = 82) diagnosed with SE in Helsinki University Central Hospital emergency room over a 2-year period. We analyzed prehospital, diagnostic, treatment, and treatment response delays based on medical records and quantitatively evaluated data availability and accuracy.
  
  
  RESULTS
  SE manifested mostly without any warning symptoms, but every fifth case presented a pre-status period. Median prehospital delay was 2 h 4 min, including delays in emergency call, ambulance arrival, and patient transportation. Median delay of diagnosing SE was 2 h 10 min. EEG-based diagnosis was significantly delayed compared to clinical diagnosis. Median delay in recording EEG was 22 h 2 min. Median delay of the first medication was 35 min, and those of second- and third-stage medications were 3 h and 2 h 55 min, respectively. We applied stepwise definition for treatment response and counted delays accordingly: total convulsion period 5 h 52 min, Burst-suppression (BS) 17 h 30 min and return of consciousness 47 h 40 min. Median treatment period in intensive care unit was 2.7 days. Mortality over treatment period (median 7.7 days) was 8.5 %. No post-discharge follow-up was performed.
  
  
  CONCLUSIONS
  Our study reveals unexpectedly and unacceptably long delays in SE management, stressing the importance of commitment to acknowledged management protocol. Delays in the treatment can and need to be shortened markedly by several strategies discussed in this article.
authors.affiliation: Department of Neurology, University of Helsinki, Helsinki, Finland. leena.ritvanen@helsinki.fi
authors.forename: Leena
authors.initials: L
authors.lastname: Kämppi
authors.forename: Harri
authors.initials: H
authors.lastname: Mustonen
authors.forename: Seppo
authors.initials: S
authors.lastname: Soinila
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis; D004282:Documentation / Q000592:standards; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006785:Hospitals, University / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D061665:Time-to-Treatment / Q000458:organization & administration* / Q000592:standards; D055815:Young Adult